1
|
Shastri A, Al Aiyan A, Kishore U, Farrugia ME. Immune-Mediated Neuropathies: Pathophysiology and Management. Int J Mol Sci 2023; 24:7288. [PMID: 37108447 PMCID: PMC10139406 DOI: 10.3390/ijms24087288] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/12/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
Dysfunction of the immune system can result in damage of the peripheral nervous system. The immunological mechanisms, which include macrophage infiltration, inflammation and proliferation of Schwann cells, result in variable degrees of demyelination and axonal degeneration. Aetiology is diverse and, in some cases, may be precipitated by infection. Various animal models have contributed and helped to elucidate the pathophysiological mechanisms in acute and chronic inflammatory polyradiculoneuropathies (Guillain-Barre Syndrome and chronic inflammatory demyelinating polyradiculoneuropathy, respectively). The presence of specific anti-glycoconjugate antibodies indicates an underlying process of molecular mimicry and sometimes assists in the classification of these disorders, which often merely supports the clinical diagnosis. Now, the electrophysiological presence of conduction blocks is another important factor in characterizing another subgroup of treatable motor neuropathies (multifocal motor neuropathy with conduction block), which is distinct from Lewis-Sumner syndrome (multifocal acquired demyelinating sensory and motor neuropathy) in its response to treatment modalities as well as electrophysiological features. Furthermore, paraneoplastic neuropathies are also immune-mediated and are the result of an immune reaction to tumour cells that express onconeural antigens and mimic molecules expressed on the surface of neurons. The detection of specific paraneoplastic antibodies often assists the clinician in the investigation of an underlying, sometimes specific, malignancy. This review aims to discuss the immunological and pathophysiological mechanisms that are thought to be crucial in the aetiology of dysimmune neuropathies as well as their individual electrophysiological characteristics, their laboratory features and existing treatment options. Here, we aim to present a balance of discussion from these diverse angles that may be helpful in categorizing disease and establishing prognosis.
Collapse
Affiliation(s)
- Abhishek Shastri
- Central and North West London NHS Foundation Trust, London NW1 3AX, UK
| | - Ahmad Al Aiyan
- Department of Veterinary Medicine, UAE University, Al Ain P.O. Box 15551, United Arab Emirates
| | - Uday Kishore
- Department of Veterinary Medicine, UAE University, Al Ain P.O. Box 15551, United Arab Emirates
| | - Maria Elena Farrugia
- Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow G51 4TF, UK
| |
Collapse
|
2
|
Effector/memory CD8 + T cells synergize with co-stimulation competent macrophages to trigger autoimmune peripheral neuropathy. Brain Behav Immun 2018; 71:142-157. [PMID: 29627532 DOI: 10.1016/j.bbi.2018.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/09/2018] [Accepted: 04/04/2018] [Indexed: 12/31/2022] Open
Abstract
Autoimmune peripheral neuropathy (APN) such as Guillain Barre Syndrome (GBS) is a debilitating illness and sometimes life threatening. The molecular and cellular mechanisms remain elusive but exposure to environmental factors including viral/bacterial infection and injury is highly associated with disease incidence. We demonstrated previously that both male and female B7.2 (CD86) transgenic L31 and L31/CD4KO mice develop spontaneous APN. Here we further reveal that CD8+ T cells in these mice exhibit an effector/memory phenotype, which bears a resemblance to the CD8+ T cell response following persistent cytomegalovirus (CMV) infection in humans and mice, whilst CMV has been considered as one of the most relevant pathogens in APN development. These activated, peripheral myelin Ag specific CD8+ T cells are required for the disease initiation. While an injury to a peripheral nerve results in Wallerian degeneration in control littermates, the same injury accelerates the development of APN in other non-injured nerves of L31 mice which have a predisposed inflammatory background consisting of effector/memory CD8+ T (CD8+ TEM) cells. However, CD8+ TEM cells alone are not sufficient. A certain threshold of B7.2 expression on nerve macrophages is an additional requisite. Our findings reveal that indeed, the synergism between CD8+ TEM cells and co-stimulation competent macrophages is crucial in inducing autoimmune-mediated peripheral neuropathy. The identification of decisive molecular/cellular players connecting environmental triggers and the occurrence of APN provides opportunities to prevent disease onset, reduce relapses and develop new therapeutic strategies.
Collapse
|
3
|
Baird-Gunning JJD, Weerasinghe D, Silsby M, Gawarikar Y, Carlino MS, Smith JL, Vucic S. Miller Fisher Syndrome Associated With Immunotherapy for Metastatic Melanoma. Neurohospitalist 2018; 8:191-193. [PMID: 30245770 DOI: 10.1177/1941874418778957] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Immunotherapy is a treatment strategy that has demonstrated survival benefit for metastatic melanoma. Ipilimumab and nivolumab are examples of immunotherapy, in which monoclonal antibodies antagonize cytotoxic T-lymphocyte-associated protein 4 and programmed death-ligand 1 receptors, respectively, resulting in upregulation of the host immune response to cancer cells. There is increasing recognition of immune-mediated adverse events associated with immune therapies in patients with cancer. We present a case report of a patient who developed Miller Fisher syndrome associated with these therapies for metastatic melanoma along with a discussion of its management.
Collapse
Affiliation(s)
| | - Dinushi Weerasinghe
- Department of Neurology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Matthew Silsby
- Department of Neurology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Yash Gawarikar
- Stroke Service, Calvary Public Hospital, Bruce, Australian Capital Territory, Australia
| | - Matteo S Carlino
- Department of Medical Oncology, Westmead and Blacktown Hospitals, the Melanoma Institute Australia and the University of Sydney, Australia
| | - Jessica L Smith
- Department of Medical Oncology, Westmead and Blacktown Hospitals, the Melanoma Institute Australia and the University of Sydney, Australia
| | - Steve Vucic
- Department of Neurology, Westmead Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
4
|
St Charles JL, Bell JA, Gadsden BJ, Malik A, Cooke H, Van de Grift LK, Kim HY, Smith EJ, Mansfield LS. Guillain Barré Syndrome is induced in Non-Obese Diabetic (NOD) mice following Campylobacter jejuni infection and is exacerbated by antibiotics. J Autoimmun 2016; 77:11-38. [PMID: 27939129 DOI: 10.1016/j.jaut.2016.09.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 08/25/2016] [Accepted: 09/04/2016] [Indexed: 01/10/2023]
Abstract
Campylobacter jejuni is a leading cause of bacterial gastroenteritis linked to several serious autoimmune sequelae such as the peripheral neuropathies Guillain Barré syndrome (GBS) and Miller Fisher syndrome (MFS). We hypothesized that GBS and MFS can result in NOD wild type (WT) mice or their congenic interleukin (IL)-10 or B7-2 knockouts secondary to C. jejuni infection. Mice were gavaged orally with C. jejuni strains HB93-13 and 260.94 from patients with GBS or CF93-6 from a patient with MFS and assessed for clinical neurological signs and phenotypes, anti-ganglioside antibodies, and cellular infiltrates and lesions in gut and peripheral nerve tissues. Significant increases in autoantibodies against single gangliosides (GM1, GQ1b, GD1a) occurred in infected NOD mice of all genotypes, although the isotypes varied (NOD WT had IgG1, IgG3; NOD B7-2-/- had IgG3; NOD IL-10-/- had IgG1, IgG3, IgG2a). Infected NOD WT and NOD IL-10-/- mice also produced anti-ganglioside antibodies of the IgG1 isotype directed against a mixture of GM1/GQ1b gangliosides. Phenotypic tests showed significant differences between treatment groups of all mouse genotypes. Peripheral nerve lesions with macrophage infiltrates were significantly increased in infected mice of NOD WT and IL-10-/- genotypes compared to sham-inoculated controls, while lesions with T cell infiltrates were significantly increased in infected mice of the NOD B7-2-/- genotype compared to sham-inoculated controls. In both infected and sham inoculated NOD IL-10-/- mice, antibiotic treatment exacerbated neurological signs, lesions and the amount and number of different isotypes of antiganglioside autoantibodies produced. Thus, inducible mouse models of post-C. jejuni GBS are feasible and can be characterized based on evaluation of three factors-onset of GBS clinical signs/phenotypes, anti-ganglioside autoantibodies and nerve lesions. Based on these factors we characterized 1) NOD B-7-/- mice as an acute inflammatory demyelinating polyneuropathy (AIDP)-like model, 2) NOD IL-10-/- mice as an acute motor axonal neuropathy (AMAN)-like model best employed over a limited time frame, and 3) NOD WT mice as an AMAN model with mild clinical signs and lesions. Taken together these data demonstrate that C. jejuni strain genotype, host genotype and antibiotic treatment affect GBS disease outcomes in mice and that many disease phenotypes are possible.
Collapse
Affiliation(s)
- J L St Charles
- Comparative Enteric Diseases Laboratory, Michigan State University, East Lansing, MI 48824, USA; Comparative Medicine and Integrative Biology Graduate Program, Michigan State University, East Lansing, MI 48824, USA; College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - J A Bell
- Comparative Enteric Diseases Laboratory, Michigan State University, East Lansing, MI 48824, USA; College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - B J Gadsden
- Comparative Enteric Diseases Laboratory, Michigan State University, East Lansing, MI 48824, USA; Comparative Medicine and Integrative Biology Graduate Program, Michigan State University, East Lansing, MI 48824, USA; College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - A Malik
- Comparative Enteric Diseases Laboratory, Michigan State University, East Lansing, MI 48824, USA; Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI 48824, USA; College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - H Cooke
- College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - L K Van de Grift
- College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - H Y Kim
- Comparative Enteric Diseases Laboratory, Michigan State University, East Lansing, MI 48824, USA
| | - E J Smith
- Comparative Enteric Diseases Laboratory, Michigan State University, East Lansing, MI 48824, USA; College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - L S Mansfield
- Comparative Enteric Diseases Laboratory, Michigan State University, East Lansing, MI 48824, USA; Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI 48824, USA; College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA.
| |
Collapse
|
5
|
Shahrizaila N, Kokubun N, Sawai S, Umapathi T, Chan YC, Kuwabara S, Hirata K, Yuki N. Antibodies to single glycolipids and glycolipid complexes in Guillain-Barré syndrome subtypes. Neurology 2014; 83:118-24. [PMID: 24920848 DOI: 10.1212/wnl.0000000000000577] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To comprehensively investigate the relationship between antibodies to single glycolipids and their complexes and Guillain-Barré syndrome subtypes and clinical features. METHODS In acute sera from 199 patients with Guillain-Barré syndrome, immunoglobulin G (IgG) antibodies to glycolipids and ganglioside complexes were tested using ELISA against individual antigens from single glycolipids including gangliosides (LM1, GM1, GM1b, GD1a, GalNAc-GD1a, GD1b, GT1a, GT1b, GQ1b) and a neutral glycolipid, asialo-GM1 (GA1), and antigens from the combination of 2 different glycolipids. Based on serial nerve conduction studies, the electrodiagnoses were as follows: 69 demyelinating subtype, 85 axonal subtypes, and 45 unclassified. RESULTS Significant associations were detected between acute motor axonal neuropathy subtype and IgG antibodies to GM1, GalNAc-GD1a, GA1, or LM1/GA1 complex. Reversible conduction failure was significantly associated with IgG antibodies to GM1, GalNAc-GD1a, GD1b, or complex of LM1/GA1. No significant association was demonstrated between acute inflammatory demyelinating polyneuropathy and any of the glycolipids or ganglioside complexes. Anti-ganglioside complex antibodies alone were detected in 7 patients (5 axonal subtype). CONCLUSIONS The current study demonstrates that antibodies to single glycolipids and ganglioside complexes are associated with acute motor axonal neuropathy or acute motor conduction block neuropathy but not acute inflammatory demyelinating polyneuropathy. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that antibodies to glycolipids are increased in patients with acute motor axonal neuropathy and acute motor conduction block neuropathy but not acute inflammatory demyelinating polyneuropathy.
Collapse
Affiliation(s)
- Nortina Shahrizaila
- From the Faculty of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Dokkyo Medical University (N.K., K.H.), Tochigi, Japan; Graduate School of Medicine (S.S., S.K.), Chiba University, Japan; National Neurosciences Institute (T.U.), Singapore; and National University Singapore (Y.-C.C., N.Y.), Singapore
| | - Norito Kokubun
- From the Faculty of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Dokkyo Medical University (N.K., K.H.), Tochigi, Japan; Graduate School of Medicine (S.S., S.K.), Chiba University, Japan; National Neurosciences Institute (T.U.), Singapore; and National University Singapore (Y.-C.C., N.Y.), Singapore
| | - Setsu Sawai
- From the Faculty of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Dokkyo Medical University (N.K., K.H.), Tochigi, Japan; Graduate School of Medicine (S.S., S.K.), Chiba University, Japan; National Neurosciences Institute (T.U.), Singapore; and National University Singapore (Y.-C.C., N.Y.), Singapore
| | - Thirugnanam Umapathi
- From the Faculty of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Dokkyo Medical University (N.K., K.H.), Tochigi, Japan; Graduate School of Medicine (S.S., S.K.), Chiba University, Japan; National Neurosciences Institute (T.U.), Singapore; and National University Singapore (Y.-C.C., N.Y.), Singapore
| | - Yee-Cheun Chan
- From the Faculty of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Dokkyo Medical University (N.K., K.H.), Tochigi, Japan; Graduate School of Medicine (S.S., S.K.), Chiba University, Japan; National Neurosciences Institute (T.U.), Singapore; and National University Singapore (Y.-C.C., N.Y.), Singapore
| | - Satoshi Kuwabara
- From the Faculty of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Dokkyo Medical University (N.K., K.H.), Tochigi, Japan; Graduate School of Medicine (S.S., S.K.), Chiba University, Japan; National Neurosciences Institute (T.U.), Singapore; and National University Singapore (Y.-C.C., N.Y.), Singapore
| | - Koichi Hirata
- From the Faculty of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Dokkyo Medical University (N.K., K.H.), Tochigi, Japan; Graduate School of Medicine (S.S., S.K.), Chiba University, Japan; National Neurosciences Institute (T.U.), Singapore; and National University Singapore (Y.-C.C., N.Y.), Singapore
| | - Nobuhiro Yuki
- From the Faculty of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Dokkyo Medical University (N.K., K.H.), Tochigi, Japan; Graduate School of Medicine (S.S., S.K.), Chiba University, Japan; National Neurosciences Institute (T.U.), Singapore; and National University Singapore (Y.-C.C., N.Y.), Singapore.
| |
Collapse
|
6
|
|
7
|
Wang D, Bhat R, Sobel RA, Huang W, Wang LX, Olsson T, Steinman L. Uncovering cryptic glycan markers in multiple sclerosis (MS) and experimental autoimmune encephalomyelitis (EAE). Drug Dev Res 2014; 75:172-88. [PMID: 24648292 DOI: 10.1002/ddr.21169] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 02/10/2014] [Indexed: 01/18/2023]
Abstract
Using an integrated antigen microarray approach, we observed epitope-spreading of autoantibody responses to a variety of antigenic structures in the cerebrospinal fluid (CSF) of patients with multiple sclerosis (MS) and in the serum of mice with experimental autoimmune encephalomyelitis (EAE). These included previously described protein- and lipid-based antigenic targets and newly discovered autoimmunogenic sugar moieties, notably, autoantibodies specific for the oligomannoses in both MS patient CSF and the sera of mice with EAE. These glycans are often masked by other sugar moieties and belong to a class of cryptic autoantigens. We further determined that these targets are highly expressed on multiple cell types in MS and EAE lesions. Co-immunization of SJL/J mice with a Man9-KLH conjugate at the time of EAE induction elicited highly significant levels of anti-Man9-cluster autoantibodies. Nevertheless, this anti-glycan autoantibody response was associated with a significantly reduced clinical severity of EAE. The potential of these cryptic glycan markers and targeting antibodies for diagnostic and therapeutic interventions of neurological disorders has yet to be explored.
Collapse
Affiliation(s)
- Denong Wang
- Tumor Glycomics Laboratory, SRI International Biosciences Division, Menlo Park, CA, 94025, USA
| | | | | | | | | | | | | |
Collapse
|
8
|
Anti-glycolipid antibodies in patients with neuropathy: A diagnostic assessment. J Clin Neurosci 2014; 21:488-92. [DOI: 10.1016/j.jocn.2013.07.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 07/18/2013] [Accepted: 07/29/2013] [Indexed: 11/20/2022]
|
9
|
Lehmann HC, Hughes RAC, Kieseier BC, Hartung HP. Recent developments and future directions in Guillain-Barré syndrome. J Peripher Nerv Syst 2013; 17 Suppl 3:57-70. [PMID: 23279434 DOI: 10.1111/j.1529-8027.2012.00433.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Guillain-Barré syndrome (GBS) encompasses a spectrum of acquired neuropathic conditions characterized by inflammatory demyelinating or axonal peripheral neuropathy with acute onset. Clinical and experimental studies in the past years have led to substantial progress in epidemiology, pathogenesis of GBS variants, and identification of prognostic factors relevant to treatment. In this review we provide an overview and critical assessment of the most recent developments and future directions in GBS research.
Collapse
Affiliation(s)
- Helmar C Lehmann
- Department of Neurology, Heinrich-Heine-University, Medical School, Moorenstrasse 5, Düsseldorf, Germany
| | | | | | | |
Collapse
|
10
|
Morata Alba J, Alpera Lacruz R. [Guillain-Barré syndrome and anti-ganglioside antibodies]. An Pediatr (Barc) 2012; 78:277-9. [PMID: 23083942 DOI: 10.1016/j.anpedi.2012.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 08/30/2012] [Accepted: 08/31/2012] [Indexed: 11/19/2022] Open
|